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The Good Doctor Continues to Infantalize its Autistic Character

Image Description: Promotional poster for the upcoming ABC show, The Good Doctor. The title appears in blue over a grainy black and white image of half of series star Freddie Highmore’s face (he is a young white man with dark hair). In contrast to the black and white, his eyes are a vibrant blue.

After watching the second episode of the new ABC series The Good Doctor (you can read my thoughts on the pilot here), I am left wondering if Dr Shaun Murphy could possibly have gone to medical school. He has a vast understanding of certain aspects of medicine and biology but no real comprehension of practical application. It leaves me wondering how he could possibly have completed a medical degree without apparently ever having been in the same room as an actual human patient.

This episode really makes Shaun seem like an alien who has never encountered humans before. This is I expect partially an attempt to highlight Shaun’s social isolation. Social isolation is a common and real aspect of the autistic experience. The show, however, takes it to an unbelievable extreme. It’s not just that Shaun has difficulty connecting with other people and experiences marginalization as a result. It’s as if he never even been around people or consumed any sort of popular media.

This is worsened by the complete lack of other autistic people in not only the show but the fictional universe in which it inhabits. Other autistic people are purely hypothetical. The concept of an autistic community is entirely absent. This allows the show to constantly juxtapose Shaun with a definition of autism that they choose rather than show that Shaun’s humanity is not contingent upon overcoming a very limited and clinical understanding of autism is. So while the show acknowledges the existence of other autistic people, they are never seen. This only highlights Shaun’s isolation because simply by virtue of being seen he is different from other autistic people.

How is it that an adult who presumably went to medical school, an endeavour that requires contact with other people like fellow students, university administrators, professors and yes even patients is not only clueless about bedside manner but who is entirely unaware of sarcasm or its purpose in communication.

I am loathed to say it but even The Big Bang Theory does it better with Sheldon Cooper because at least he is aware of sarcasm even if he can’t always recognize it.

It is entirely possible and in fact likely that an autistic person be both aware of sarcasm, have a theoretical understanding of its usage and purpose, and still have difficulty recognizing it in conversation. It is rather unbelievable that a man in his twenties whose life experience clearly brought him into contact with other people would need to ask a colleague the purpose of sarcasm. It would almost certainly have already been used to belittle him before.

Shaun Murphy clearly cares about people. Making his empathy clear is one of the few positives of the show. Yet, somehow the show wants us to believe that this caring has always occurred at a distance.

In some ways this utter cluelessness about people, makes the concerns of the show’s villains (those doctors who don’t want Shaun practising) seem valid. This seems to be a decision that replaces the more common narrative device of having the autistic character be the butt of jokes (though that happens in this episode too) with just utterly cringe-inducing interactions.

Somehow, Shaun got all the way through medical school and not have been coached in any way on bedside manner. He makes most of his patients uncomfortable or outright distressed.

In a subplot pulled directly from show creator David Shore’s previous medical drama House, a patient brings in a baggie of their own vomit (though in House it was their own poop and no, no one had requested a stool sample). The nurse supervising Shaun (because of course, they are infantilizing him) is horrified but Shaun just wants to run unnecessary tests.

Apparently, no one ever explained to Shaun that it is not only unnecessary but also inadvisable to run every possible test. No one ever explained statistics (something I presume he would be very good at) or how they can be used to determine the likelihood if a given test outcome and indicate the level of risk to not performing the test.

Shaun seems to think that it is reasonable to perform tests if there is even the smallest chance that something might be found.

This suggests that Shaun has also despite being self-described as poor never had medical insurance explained to him. Does no one in this universe have to pay the bills for the things he does? I mean maybe? It’s already clear that the ADA doesn’t exist in this universe so why would the rest of the infrastructure of the American healthcare system (which I’m sure gets discussed at some point during medical school) exist either?

There is really no reason for Shaun to be this clueless. He should have met checks and balances in med school and in interactions with fellow students, teachers and patients. I really need to see flashbacks to his medical school days. How were none of these concerns identified and addressed then?

It’s hard to believe they wouldn’t have been but that would require the character to be more complex. They would have to show the effort that autistic people expend to analyze and navigate personal interactions. Shaun is, however, not a complex character he is meant to be innocent and guileless.

Sarah Luterman, who has been doing episode breakdowns has twice described this infantilizing characterization to a T. First, by saying

“So far, The Good Doctor is basically House, if House was an adorable talking kitten instead of a pill-popping curmudgeon”

“There is no adult human with a medical degree as naive as Dr. Sean Murphy. It’s ridiculously bad writing. Sean Murphy is not written like an autistic man, he’s written two autistic children standing on each other’s shoulders.”

The show has been confirmed for at least a complete first season and I do expect that there will be some personal growth for Dr Shaun Murphy in it. I however don’t expect them to ever answer the question of why none of that growth was possible prior to the events of the show?

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15 responses to “The Good Doctor Continues to Infantalize its Autistic Character”

I am dividing my critique of The Good Doctor into “autism doesn’t work like that!” and “residency/medicine doesn’t work like that!”

The “residency/medicine doesn’t work like that” is actually the bigger problem here and my main critique of the second episode. Because Shaun would absolutely have been taught how to go down to the lab and get results from the pathologist. He would have been taught to discharge a patient (and patients do not typically get exit exams the way they portrayed.) Shaun is basically being presented as someone who swallowed a medical textbook rather than someone who just completed several years of training in hospitals similar to this one.

Then they are blaming his autism for the fact that he apparently didn’t go to medical school or apply for residency through typical channels.

Of course, this show is from the creators of House, and medicine/fellowship didn’t work like that either.

i would love to have an autistic doctor as my gp. most doctors are in their lwn world, interrupt all the time, start to speak in medicalese, infantilize their customers, and in many other ways have terrible bedside manners.
so having some asd representation in the actual medical world is good

I’m fairly certain he went to medical school, he even stated this fact to the surgeon he was working with “There were many surgeons in the school I went to who were like you” or something to that accord. No where do they state he didn’t go to medical school, he wouldn’t even legally be able to be a surgeon without going to medical school, that’s a lawsuit waiting to happen.

However, it would be nearly impossible to attend, let alone graduate from medical school, without a greater understanding of how medical systems work. He has an encyclopedic knowledge about medical conditions, etiology, diagnoses and treatment, but is portrayed as having minimal knowledge about hospitals and the actual practice of medicine in context.

It doesn’t help, of course, that his hospital and residency program are portrayed as operating in ways that are not consistent with any other hospital or residency program I have ever experienced or observed. Hospitals and programs differ, but there are great gaping errors in the way residency hiring and education is portrayed. (Most medical shows make errors in this area. Some make greater errors than others.)

And sure, autism can make it harder to adapt to a new hospital system. One thing I experienced as an autistic resident was being posted to a new hospital which used entirely different acronyms and shorthand in their emergency room than several prior hospitals I had experienced. I had medical knowledge but not local knowledge. And sure, autism can make it harder to navigate situations such as interacting with teammates or staff in other departments. Those would be great things to show.

But overall, Shaun is portrayed as someone who has never been exposed to hospital procedures, rather than someone who struggles to navigate the nuances of them in a new environment.

Of course, real residents are given orientation. And real residents are given supervision. Shaun Murphy has had neither of these things, at least not on screen. And when he screws up, they are quick to blame autism rather than the lack of training and supervision.

“This episode really makes Shaun seem like an alien who has never encountered humans before…. It’s not just that Shaun has difficulty connecting with other people and experiences marginalization as a result. It’s as if he never even been around people or consumed any sort of popular media.”

I have a hypothesis about why this often seems to be the case with autistic characters:

I started to write how I felt about the character in this show, but really, all I can think of when I watch is how wonderful Ryan Cartwright was as Gary in Alphas. I don’t know anyone with autism but I read that his performance was highly praised. I hope I’m remembering correctly. Sorry for being off topic, but as brilliant as Freddie Highmore is, Ryan Cartwright surpasses him as a man with autism, in my opinion.

I agree. You would think throughout his life he’s had some understanding of some these emotions by now. He also had a brother that seemed to teach him a lot about human connections before he died. I mean they’re making it out to be like the world is all new to him, on top of working in a hospital for the first time, which it shouldn’t be. Maybe they just needed to fill in a script and wrote it that way so the audience can to relate to him more.
This is a show that I’ll watch when I’ve got nothing else to watch. I don’t love it but I don’t hate it either. I just wish Shaun Murphy would stop talking like a gosh darn robot! It gets worst with every episode! I don’t think autistic people have to sound bionic. I wish Freddie Highmore could retrain himself on how he speaks on the show because he’s killing it for me.

I also had all the same issues you do. I have worked with the autism population for over 20 years. The other issues I have with the characterization is that he doesn’t like answering questions, yet as you pointed out, he could have never made it through medical school. Second his voice inflections. It’s like he is a robot. Yes, autistic people have trouble sometimes with abstract concepts like emotions, that doesn’t mean they are devoid of them, or how voice tone, inflection, social cues and other social interaction works.

Third, the savant autstic aharacter. I get in this context it may be necessary, but that seems to be the default view. This idea gets perpetuated that all people with autism posses extrodinary abilities, which diminishes all people in the spectrum, that rather then savants, they can live just like anyone else.

So much about this show irritates me as an autistic adult. I think you’ve covered most of my thoughts, but I really don’t get the fact that he won’t answer questions. Why not? How did he make it through grade school let alone medical school if he won’t answer questions? Autistic people don’t actually do things (or avoid doing things) for no reason, contrary to popular media, but it appears like Shaun doesn’t answer questions simply because he doesn’t want to. I also have trouble with the way the general public might interpret certain things about Shaun and other characters like him. They may not understand why around 90% of autistic adults are unemployed or underemployed, and that could lead to some harsh judgments about those of us who can only work part time or not at all. After all, they might think, if someone as impaired as Shaun Murphy can easily handle a full time, extremely high-stress job, why can’t someone like me who comes across as far more “normal” do the same? I’m honestly afraid of that sort of judgement coming along.

I have to say I like the interactions between Shaun and Claire (one neurotypical who is actually making the effort to understand Shaun’s condition) but the ones between Shaun and the hospital’s newest doctor make me cringe. “I get that you’re autistic” Dr.
Morgan Reznick says in a rather snide tone, a comment which isn’t called out as it should be. And the nerve of her to say that he didn’t understand why a patient was upset. Autistics may not understand human behaviour, but three
things they are made aware of are bigotry, discrimination and ignorance. I knew what all three were before I knew what the words meant. Of course, Reznick’s attitude pales in comparison to what Shaun’s father did.
Killed Shaun’s pet rabbit and refused to accept his autism. Families who turn against an autistic member don’t deserve to have any children in their lives at all. You accept your children no matter what. Refuse to do so, and those children considered different will say worse than “I hate fathers.” I cut my paternal grandmother out of my own life because she wouldn’t accept me. I didn’t even go to her funeral when she died, because I would have
felt like a hypocrite listening to the lies told about her being a wonderful person. Besides, I hadn’t seen her in almost ten years. She wouldn’t have known me anyway (dementia). This is why I am more upset when families hold ableist attitudes. With society, I’ve come to expect it. They don’t understand autism until it happens to them. But even then, that person with autism would probably be nothing like Shaun Murphy, Sheldon from “Big Bang Theory” or even Rain Man. All three have provoked the reaction “This is not me.” Still, it could be anyone. Maybe.